Bifrontal headache • blurred vision • vomiting • Dx?
Treatment targets the underlying causes
Treatment options for PRES are limited. Hypertension in a patient with PRES requires prompt intervention to avoid progression of the disease.2 The use of intravenous (IV) calcium-channel blockers or IV beta-blockers for these patients is common.2,8
Patients with seizures should be treated with anticonvulsant medication, but longterm antiepileptic treatment usually is not required.2 Patients who take immunosuppressant or cytotoxic drugs should stop them indefinitely upon presenting with PRES.2
For a pregnant woman with preeclampsia/eclampsia, delivery of the placenta, which is considered to be the cause of PRES in these cases, is curative.1 However, women can develop PRES several weeks after delivery.1
In most cases, the symptoms associated with PRES will resolve once treatment is initiated, and neurologic recovery can be expected within 2 weeks.2
Our patient regained her sight the following morning and was discharged home 2 days after admission. Her blood pressure remained normal. She returned to the hospital unresponsive the day after she had been discharged. Family members stated that she had taken 15 packets of an aspirin/caffeine combination to control a new headache.
Her blood pressure was elevated at 159/79 mm Hg. A CT of the brain showed a hemorrhagic stroke within the left occipital lobe and posterior parietal lobe with a midline shift of 8 mm. We don’t know if the aspirin use contributed to the hemorrhagic event or if it was a sequela of PRES.
The patient died 4 days later.
THE TAKEAWAY
PRES is a neurotoxic condition that causes headache, seizures, and vision loss. Most patients will present with elevated blood pressure and imaging studies will reveal a specific pattern of vasogenic edema that is predominately found in the parietal and occipital regions.
Treating the hypertension may result in a more favorable recovery. Normotensive patients are harder to treat because there is no specific therapy for PRES. Follow-up imaging may help to assess the resolution of the syndrome.
